Serum sodium independently predicts resistant Kawasaki disease

Biologic and echocardiography criteria are associated with resistant Kawasaki disease (KD), but only serum sodium is an independent predictive factor, according to a study, noting that a score to predict resistant KD cannot be established yet.

This retrospective multicentre study aimed to establish criteria to predict resistant KD in a representative French population and to develop a predictive score. It was conducted in two universities and five secondary hospitals in Eastern France and included patients from 1 January 2010 through 31 December 2019. The investigators recorded KD diagnosis to the European Single Hub and Access point for paediatric Rheumatology in Europe (SHARE) initiative criteria.

Of the 202 eligible patients with KD, 194 were included in the analysis (160 sensitive KD and 34 [17.5 percent] resistant KD).

Univariate analysis revealed that serum sodium <133 mmol/L (odds ratio [OR], 2.97, 95 percent confidence interval [CI], 1.40–6.45), haemoglobin level <110 g/L (OR, 3.17, 95 percent CI, 1.46–7.34), neutrophils >80 percent (OR, 2.36, 95 percent CI, 1.03–5.25), C-reactive protein level >150 mg/L (OR, 4.47, 95 percent CI, 2.07–10.19), coronary artery abnormalities (CAAs; OR, 3.85, 95 percent CI, 1.67–8.79), or myocarditis (OR, 6.98, 95 percent CI, 1.47–36.95) at diagnosis were significantly associated with resistant KD. However, only serum sodium was an independent predictive factor.

“Resistant KD represents 10–15 percent of KD patients and increases risk of CAAs,” the investigators said. “Different scores exist to predict resistant KD but only in Japanese population.”